If your
physicians aren't documenting the time spent on discharges,
your rightful reimbursement could be walking away along
with the patient.

Medicare
recognizes two codes for discharge planning: 99238 (30 minutes
or less) and 99239 (more than 30 minutes). "A lot of
the doctors are spending more than 30 minutes with their
patients in discharge planning but they don't document that,"
says Charol Spaulding, vice president of Coding Continuum
of Tucson, AZ. "I have rarely seen any physicians document
time on a discharge summary, even if they bill 99239."

The
30-plus minutes don't need to be continuous. "There
could be 25 minutes in the morning and 12 minutes later
in the day," says Collette Shrader, compliance/education
coordinator with the Wenatchee Valley Medical Center in
Wenatchee, WA. Also, the physician doesn't need to document
stop and start times in detail, says Shrader. Instead, the
physician can simply write down "37 minutes" without
breaking down the time further.

Many
physicians simply want to bill 99238, because they don't
want to bother to document time, notes Shrader. And when
physicians do want to bill 99239, they sometimes don't provide
enough documentation to make the code possible.

The
good news is you can improve your coding by educating your
physicians on this topic. "We have discussions with
[physicians] on a regular basis," encouraging them
to document time to avoid being stuck with 99238, says Jennie
Horner, a coder with Southern Ohio Medical Center in Portsmouth,
OH. Her department does regular audits to look for documentation
of time. A lot of physicians never bother to bill 99239,
or else by the time they get around to doing their charge
logs, they don't remember whether they documented time spent.
But Horner tells physicians that "over a period of
time, it really does add up, and they're doing work they're
not getting paid for properly."

Horner
and other experts say that regular education can improve
your physicians' batting average with discharge coding.